Osseous metaplasia in gliosarcoma: an unusual histologic finding. Case report

Cambruzzi, Eduardo; Pêgas, Karla Lais

doi:10.5935/1676-2444.20140010

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Jornal Brasileiro de Patologia e Medicina Laboratorial

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Pathology • J. Bras. Patol. Med. Lab. 50 (2) • Mar-Apr 2014 • https://doi.org/10.5935/1676-2444.20140010 copy

Osseous metaplasia in gliosarcoma: an unusual histologic finding. Case report

Metaplasia óssea no gliossarcoma: um achado histológico pouco usual. Relato de caso

Authorship SCIMAGO INSTITUTIONS RANKINGS

Gliosarcoma (GS) is a malignant neoplasm of the central nervous system that has coexisting glial and mesenchymal components. GSs are rarely related to osseous metaplasia. The authors report a case of GS in a male patient presenting apathy and catatonia. Computed tomography/magnetic resonance imaging showed an expansive process affecting the left frontal lobe. At microscopy, a malignant glioma constituted by highly atypical glial cells intermingled with spindle-shaped cells was identified. The lesion showed areas of necrosis with pseudopalisading formation, focus of osseous metaplasia, and positive immunoexpression of S100, CD99 and vimentin in both elements. Only the sarcomatous component exhibited negative immunoexpression of glial fibrillary acidic protein (GFAP). The diagnosis of GS was then established.

gliosarcoma; central nervous system neoplasms; pathology; brain neoplasms; glioblastoma

Authors	Age/gender	Clinical findings	Topography	Treatment modality	Outcome
Andaloussi-Saghir et al. ⁽²2 ANDALOUSSI-SAGHIR, K. et al. Secondary gliosarcoma after the treatment of primary glioblastoma multiforme. N Am J Med Sci, v. 3, n. 11, p. 527-30, 2011.)	48 years/M	Dizziness	Temporal lobe	Surgery + radiotherapy + chemotherapy	Died after 27 months due to tumor recurrence
		Headache
		Seizures
Chen et al ⁽⁶6 CHEN, L. et al. A case study of a patient with gliosarcoma with an extended survival and spinal cord metastases. Cell Biochem Biophys, v. 62, n. 2, p. 391-5, 2012.⁾	31 years/F	Dizziness	Cerebrum	Surgery + radiotherapy + chemotherapy	Developed metastases to liver, lymph nodes, skeletal and spinal cord
		Headache
		Vomiting
Demirci et al. ⁽⁸8 DEMIRCI, S. et al. Multiple spinal metastases of cranial gliosarcoma: a case report and review of the literature. J Neurooncol, v. 88, n. 2, p. 199-204, 2008.⁾	68 years/F	Headache	Cerebrum	Surgery + radiotherapy	Developed metastasis to the thoracic spinal cord
	68 years/F	Hemiplegia	Cerebrum	Surgery + radiotherapy	Developed metastasis to the thoracic spinal cord
Jimenez et al.⁽⁹9 JIMENEZ, C. et al. Sarcoma arising as a distinct nodule within glioblastoma: a morphological and molecular perspective on gliosarcoma. J Neurooncol, v. 105, n. 2, p. 317-23, 2011.⁾	65 years/F	Weakness	Frontal lobe	Surgery	Unavailable
		Seizures
		Hemiparesis
Maeda et al.⁽¹²12 MAEDA, D. et al. Temporal gliosarcoma with extraneural metastasis: case report. Neurol Med Chir (Tokyo), v. 50, n. 4, p. 343-5, 2010.⁾	51 years/F	Headache	Temporal lobe	Surgery	Developed lung metastasis
Mesfin et al.⁽¹⁴14 MESFIN, F. B. et al. Metastatic gliosarcoma with a unique presentation and progression: case report and review of the literature. Clin Neuropathol, v. 29, n. 3, p. 147-50, 2010.⁾	51 years/F	Generalized tonicclonic seizures	Temporal lobe	Surgery + radiotherapy + chemotherapy	Developed lung metastasis
Moon et al.⁽¹⁵15 MOON, S. K. et al. Gliosarcoma of the cerebellar hemisphere: a case report and review of the literature. Korean J Radiol, v. 11, n. 5, p. 566-70, 2010.⁾	70 years/F	Headache	Cerebellum	Surgery	Unavailable
Neelima et al.⁽¹⁷17 NEELIMA, R. et al. Pediatric gliosarcoma of thalamus. Neurol India, v. 60, n. 6, p. 674-6, 2012.⁾	11 years/M	Headache	Thalamus	Surgery	Unavailable
	11 years/M	Vomiting	Thalamus	Surgery	Unavailable
Okami et al.⁽¹⁸18 OKAMI, N. et al. Infantile gliosarcoma: a case and a review of the literature. Childs Nerv Syst, v. 18, n. 6-7, p. 351-5, 2002.⁾	23 months/M	Headache	Frontal lobe	Surgery	Died 2 months after surgery
	23 months/M	Vomiting	Frontal lobe	Surgery	Died 2 months after surgery
Ravisankar et al.⁽²¹21 RAVISANKAR, S. et al. Pediatric gliosarcoma with fibrosarcomatous differentiation: report of a rare case. Indian J Pathol Microbiol, v. 55, n. 4, p. 521-4, 2012.⁾	11 years/M	Headache	Temporoparietal region	Surgery + radiotherapy + chemotherapy	Unavailable
	11 years/M	Vomiting	Temporoparietal region	Surgery + radiotherapy + chemotherapy	Unavailable
Sarkar et al.⁽²²22 SARKAR, H. et al. Pure intraventricular origin of gliosarcoma - a rare entity. Turk Neurosur, v. 23, n. 3, p. 392-4, 2013.)	60 years/F	Headache	Septal region andbody/frontal horn of the lateral ventricles	Surgery + chemotherapy	Unavailable
		Vomiting
		Intracranial hypertension
Present report	56 years/M	Abulia and catatonia	Frontal lobe	Surgery	Died 3 months after surgery

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[1] MAILING ADDRESS: Eduardo Cambruzzi Hospital Conceição de Porto Alegre; Laboratório de Patologia B; Av. Francisco Trein, 596, 2º andar; Cristo Redentor; CEP: 91350-200; Porto Alegre-RS, Brazil; e-mail: dudacambruzzi@yahoo.com.br.